ESC Congress 2026 Abstract · Oct 26, 2026

Differences in outcomes according to the type of heart failure and kidney disease stages in patients with heart failure and chronic kidney disease

By Anguita Gamez M, Esteban Fernandez A, Bonillas Palomas JL et al.

Introduction: Heart failure (HF) has a high mortality and incidence of decompensation. Chronic kidney disease (CKD) is very prevalent in patients with HF and worsens their prognosis. Few information is known about the interaction between severity of CKD and the type of HF, reduced (HFrEF), mildly reduced (HFmrEF) and preserved (HFpEF), in terms of drug treatment and prognosis, Purpose: To analyze in a contemporary registry of HF patients followed in HF units in Spain the differences in clinical characteristics, treatment and 1-year outcomes between patients with HFrEF, HFmrEF and HFpEF according to CKD stage (4-5 versus 1-3). Methods: We analyzed data from the registry of the SEC-Excelente-IC quality accreditation program of the Spanish Society of Cardiology, with 2,245 patients with HF included between 2019 and 2024 by 68 specialized HF units. Patients were included consecutively in two 1-month cutoffs (March and October) in that period. Clinical characteristics, treatment and 1-year mortality and HF hospitalization rates were compared in HFrEF, HFmrEF and HFpEF patients according to CKD stages 4-5 and 1-3. Results: Of the 2,245 patients, 54.2% were HFrEF, 12% HFmrEF and 33.8% HFpEF. CKD stages 4-5 were present in 9.9% (8.9% of HFrEF, 11.5% of HFmrEF and 11.3% of HFpEF patients). Median age was 73 years (IQR 63-80), being older in CKD 4-5 stages, and 37.3% were female, without differences between HF type and CKD severity. Figure 1 shows the drug treatment in all subgroups of patients. CKD 4-5 patients received in significantly lower proportion ARNI, MRA, betablockers and SGLT2i in HFrEF and HFmrEF. One-year mortality and 1-year rate of HF hospitalizations were significantly higher in patients with HFrEF and lower in those with HFpEF in cases of CKD 4-5, but there were no differences among the three types of HF in the CKD 1-3 subgroup (figure 2). Conclusions: In this contemporary cohort of patients with HF, an interaction was observed between renal dysfunction and the type of HF on 1-year mortality and hospitalization rates, with significant differences in event rates between HF types only in cases of more severe renal dysfunction (CKD stages 4-5).Drug treatment in all subgroups of patientsOne-year outcomes in the 3 types of HF

doi.org/10.1093/eurheartj/ehag785.3961Open accessPopulations